Provider Demographics
NPI:1952546962
Name:OKLAHOMA ONCOLOGY AND HEMATOLGY PC
Entity Type:Organization
Organization Name:OKLAHOMA ONCOLOGY AND HEMATOLGY PC
Other - Org Name:CANCER CARE ASSOCIATES SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:BUKOFZER
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:918-499-2153
Mailing Address - Street 1:4401 W MEMORIAL RD
Mailing Address - Street 2:STE 138
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1785
Mailing Address - Country:US
Mailing Address - Phone:405-936-2825
Mailing Address - Fax:405-936-2895
Practice Address - Street 1:4401 W MEMORIAL RD
Practice Address - Street 2:STE 138
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-1785
Practice Address - Country:US
Practice Address - Phone:405-936-2825
Practice Address - Fax:405-936-2895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-04
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK153483336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100744480 BMedicaid
3725629OtherNCPDP PROVIDER IDENTIFICATION NUMBER
0648100019Medicare NSC